The Value Of Preoperative Neutrophil-lymphocyte Ratio And Prognostic Nutritional Index In The Prognosis Assessment Of Patients With Bladder Cancer After Radical Cystectomy

Objective Some studies have shown that preoperative systemic inflammation and nutritional status were closely related to the prognosis of the cancer.In bladder cancer,preoperative detection of systemic inflammation and nutritional indicators to assess the prognosis of patients has rarely been reported.To explore their relationship with clinicopathological features and prognosis in patients with bladder cancer underwent radical cystectomy,this study examined neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),systemic immune-inflammation index(SII),lymphocyte-monocyte ratio(LMR),and prognostic nutritional index(PNI).Methods A retrospective study of 213 patients with bladder cancer who underwent radical cystectomy in the First Affiliated Hospital of Anhui Medical University between January 2012 to November 2017.According to ROC curve,the optimal cut-off values of preoperative NLR,PLR,SII,LMR and PNI were determined and divided into high and low groups.The relationship between preoperative NLR,PLR,SII,LMR and PNI and clinicopathological features was analyzed.Cox proportional risk model was used to analyze the potential prognostic factors such as NLR,PLR,SII,LMR,PNI,age,gender,hydronephrosis,histological grade,pathological T stage,tumor size,tumor number,etc.Results(1)Determine the optimal cut-off values for NLR,PLR,SII,LMR,and PNI from the ROC curve.Low NLR group(NLR<2.89)and high NLR group(NLR?2.89);low PLR group(PLR<162.89)and high PLR group(PLR?162.89);low SII group(SII<557.45)and high SII group(SII)?557.45);low LMR group(LMR<4.81)and high LMR group(LMR?4.81);low PNI group(PNI<46.08)and high PNI group(PNI?46.08).(2)NLR is related to pathological T stage,tumor size and tumor number;PLR is related to gender and pathological T stage;SII is related to histological grade and pathological T stage;LMR is related to gender,age and pathological T stage;PNI is related to age and smoking history.(3)Multivariate analysis showed that NLR(P=0.007),PNI(P=0.004),age(P=0.044),hydronephrosis(P=0.001),histological grade(P=0.009),pathological T stage(P <0.001)were independent risk factors for overall survival(OS)of patients underwent radical cystectomy;NLR(P=0.016),PNI(P=0.008),hydronephrosis(P=0.011),histological grade(P=0.035),and pathological T stage(P<0.001)were independent risk factors for recurrence-free survival(RFS)of patients underwent radical cystectomy.(4)The mean overall survival of patients with low NLR and high NLR was58.5 months and 36.2 months(P<0.05).The mean recurrence-free survival was 56.5months and 35.7 months(P<0.05).The mean overall survival of patients with low PNI and high PNI was 33.6 months and 54.6 months(P<0.05);the mean recurrence-free survival was 35.0 months and 52.5 months(P<0.05).Conclusion NLR and PNI are independent factors affecting the prognosis of patients underwent radical cystectomy,and have a good prognostic evaluation.In clinical work,these two indicators are easy to detect and obtain,and can be obtained by routine preoperative examination.NLR ? 2.89 and/or PNI < 46.08 predicted that the overall survival and recurrence-free survival of patients with radical cystectomy were short.